Malnutrition Is Highly Prevalent in Patients With Chronic Pancreatitis and Characterized by Loss of Skeletal Muscle Mass but Absence of Impaired Physical Function

Abstract

Background/aims: Patients with chronic pancreatitis (CP) have an increased risk of malnutrition, a condition linked to reduced muscle mass and physical performance. We have investigated the risk factors, phenotypic presentation, and health implications associated with malnutrition in CP.

Materials and methods: In a multicenter cross-sectional study we recruited patients with confirmed CP and healthy volunteers as a control group. Malnutrition was diagnosed according to the criteria proposed by the Global Leadership Initiative on Malnutrition. We performed detailed examinations of body composition and physical function as well as testing of routine blood parameters and markers of inflammation.

Results: We included 66 patients [mean (±SD) age: 56.0 (±14.5) years; 51 males] and an equal number of age- and sex-matched controls. Moderate malnutrition was diagnosed in 21% (n = 14) and severe malnutrition in 42% (n = 28) of patients. Besides weight loss malnourished patients showed lower fat and skeletal muscle mass compared to both non-malnourished subjects and healthy controls. Only in severe malnutrition, blood parameters reflected elevated inflammation and reduced muscle reserves. Handgrip strength in patients did not differ by nutritional status but there was a significant correlation (rho = 0.705, p < 0.001) with skeletal muscle mass. Although 20 patients (30%) had pathologically reduced skeletal muscle mass, only two individuals (3%) had sarcopenia with concomitantly reduced handgrip strength.

Conclusion: Malnutrition is a frequent complication of CP characterized by loss of skeletal muscle mass. As this condition becomes evident only at an advanced stage, regular testing for altered body composition is recommended. Suitable biomarkers and the link between loss of muscle mass and physical function require further investigation.

Clinical trial registration: [https://ichgcp.net/clinical-trials-registry/NCT04474743], identifier [NCT04474743].

Keywords: GLIM; chronic pancreatitis; handgrip strength; malnutrition; sarcopenia.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Wiese, Gärtner, von Essen, Doller, Frost, Tran, Weiss, Meyer, Valentini, Garbe, Metges, Bannert, Sautter, Ehlers, Jaster, Lamprecht, Steveling, Lerch and Aghdassi.

Figures

FIGURE 1

Jellyfish plots of anthropometric and body composition parameters in patients with chronic pancreatitis stratified by nutritional status and healthy controls. Distribution of data is presented as a combination of histogram (left), mean ± SD (center), and kernel density estimated probability density function (right). Differences between groups were tested by two-tailed t-test. *p < 0.05, **p < 0.01, ***p < 0.001.

FIGURE 2

Correlation between skeletal muscle mass index and maximum handgrip strength in patients with chronic pancreatitis. Data is presented stratified by nutritional status and sex. Vertical and horizontal lines indicate sex-specific thresholds of sarcopenia for skeletal muscle mass and handgrip strength, respectively. Spearman’s correlation coefficient was calculated to measure the strength and direction of association between the two variables.